Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin.

Abstract

OBJECTIVE:

Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise.

RESEARCH DESIGN AND METHODS:

Using a randomized crossover design, 49 children 8-17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from approximately 4:00-5:00 p.m., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise.

RESULTS:

Hypoglycemia (< or = 70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P = 0.003). Hyperglycemia (increase from baseline of > or = 20% to > or = 200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P = 0.002). There were no cases of abnormal blood ketone levels.

CONCLUSIONS:

Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.

• Authors: Diabetes Research in Children Network (DirecNet) Study Group, Eva Tsalikian, Craig Kollman, William B Tamborlane, Roy W Beck, Rosanna Fiallo-Scharer, Larry Fox, Kathleen F Janz, Katrina J Ruedy, Darrell Wilson, Dongyuan Xing, Stuart A Weinzimer
• Journal: Diabetes care (Diabetes Care) Vol. 29 Issue 10 Pg. 2200-4 (Oct 2006) ISSN: 0149-5992 [Print] United States
• PMID: 17003293 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose

Topics

• Adolescent
• Blood Glucose (metabolism)
• Child
• Diabetes Mellitus, Type 1 (drug therapy)
• Exercise (physiology)
• Female
• Humans
• Hypoglycemia (prevention & control)
• Infusion Pumps, Implantable
• Insulin Infusion Systems
• Male